A hysterotomy is a surgical incision made into the uterus, most commonly performed during a cesarean delivery to remove a baby. The term comes from the Greek words “hystera” (uterus) and “tome” (cutting). While it sounds similar to “hysterectomy,” the two are very different procedures. A hysterotomy opens the uterus but leaves it in place, while a hysterectomy removes the uterus entirely.
How a Hysterotomy Differs From a Hysterectomy
The one-letter difference between these terms causes frequent confusion, but the procedures have completely different purposes and outcomes. A hysterotomy is an incision into the uterine wall, after which the uterus is typically repaired and left intact. You retain your uterus and can potentially become pregnant again in the future. A hysterectomy, on the other hand, is the permanent surgical removal of the uterus. After a hysterectomy, pregnancy is no longer possible.
Think of it this way: a hysterotomy is to the uterus what an incision is to any other organ during surgery. The surgeon cuts in, does what needs to be done, and closes the organ back up. A hysterectomy is a removal.
When a Hysterotomy Is Performed
The most common reason for a hysterotomy is a cesarean section (C-section). During a C-section, the surgeon makes an incision through the abdominal wall and then a second incision through the uterine wall to deliver the baby. That uterine incision is the hysterotomy. After the baby and placenta are delivered, the uterus is stitched closed in layers.
Beyond cesarean delivery, hysterotomy may be performed in several other situations:
- Fetal surgery: In rare cases, surgeons need to operate on a baby while it is still in the uterus. The uterus is opened, the procedure is performed on the fetus, and the uterus is closed so the pregnancy can continue.
- Removal of uterine fibroids: When large fibroids grow within the uterine wall, a surgeon may need to cut into the uterus to remove them. This is more commonly called a myomectomy, but the technique involves the same type of uterine incision.
- Second-trimester pregnancy termination: In uncommon circumstances where other methods are not suitable, a hysterotomy may be used to end a pregnancy in the second trimester. This is rare in modern practice because less invasive options are available.
- Molar pregnancy removal: When abnormal tissue grows in the uterus instead of a normal pregnancy, a hysterotomy may occasionally be needed to remove it.
Types of Uterine Incisions
The direction and location of the incision on the uterus matters for healing and for any future pregnancies. The most common type is a low transverse incision, which is a horizontal cut made across the lower, thinner part of the uterus. This area has less muscle and fewer blood vessels, so it heals more reliably and carries a lower risk of complications in future pregnancies.
A classical (vertical) incision runs up and down through the thicker, upper portion of the uterus. Surgeons use this approach when they need more room, such as during very early preterm deliveries when the lower part of the uterus hasn’t stretched enough, or when the baby is in an unusual position. The trade-off is that a vertical incision creates a weaker scar, which increases the risk of the uterus rupturing during a future labor. People who have had a classical hysterotomy are generally advised to deliver future pregnancies by planned C-section rather than attempting vaginal birth.
It’s worth noting that the incision on your skin and the incision on your uterus don’t always match. You can have a horizontal skin incision (the “bikini cut”) but a vertical uterine incision underneath. Your surgical records, not the visible scar, determine what type of hysterotomy you had.
What Recovery Looks Like
Recovery from a hysterotomy depends on why it was performed. After a cesarean delivery, most people stay in the hospital for two to four days. The uterine incision heals over several weeks, though full recovery of the tissue typically takes six to eight weeks. During this time, you’ll likely experience cramping as the uterus contracts back to its normal size, along with vaginal bleeding that gradually tapers off.
Physical activity is usually restricted for the first several weeks. Lifting anything heavier than your baby is generally discouraged during early recovery. Most people can return to normal daily activities within six weeks, though everyone heals at a different pace.
For hysterotomies performed during fetal surgery, the recovery period can be more complex because the pregnancy is ongoing. Bed rest and close monitoring are standard, and there is an elevated risk of preterm labor because the uterine incision can irritate the muscle and trigger contractions.
Risks and Potential Complications
Any surgical incision into the uterus carries risks, including bleeding, infection, and damage to surrounding organs like the bladder or bowel. The uterus has a rich blood supply, so significant bleeding during or after the procedure is one of the primary concerns surgeons manage.
The longer-term risk that matters most for many people is how the scar affects future pregnancies. Uterine scar tissue can influence where the placenta attaches in a subsequent pregnancy. A condition called placenta accreta, where the placenta grows too deeply into the uterine wall at the scar site, becomes more likely with each additional hysterotomy. This is one reason why the risk profile of cesarean deliveries increases with each successive surgery.
Uterine rupture, where the scar opens during labor, is rare but serious. The risk is highest with classical vertical incisions (estimated at 2% to 9% during subsequent labor) and much lower with low transverse incisions (under 1%). This difference is the main reason your type of uterine incision determines whether vaginal birth after cesarean (VBAC) is considered a safe option for you.
Impact on Future Pregnancies
Having a hysterotomy does not prevent you from becoming pregnant again, but it does change how future pregnancies are managed. Your care team will want to know the type, location, and number of prior uterine incisions. Most guidelines recommend waiting at least 18 months after a cesarean hysterotomy before becoming pregnant again, giving the uterine scar adequate time to heal and regain strength.
During subsequent pregnancies, the scar site is monitored for signs of thinning or abnormal placental attachment. If you had a low transverse incision and an uncomplicated recovery, you may be a candidate for VBAC. If you had a classical incision, multiple prior hysterotomies, or other complicating factors, a planned repeat cesarean is the standard recommendation to avoid the risk of rupture during labor.